Joint Budget Committee Hearing - Colorado · Source: Denver Chamber 19 Health Care Impact on Our...

Joint Budget Committee Hearing:

Executive Director’s Office

Kim Bimestefer, Executive Director;

John Bartholomew, Finance Office Director;

Josh Block, Budget Director;

Tom Massey, Policy, Communication & Administration

Office Director

December 17, 2018

https://www.colorado.gov/hcpf/legislator-resource-center

Our Mission

Improving health care access and

outcomes for the people we serve

while demonstrating sound

stewardship of financial resources

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• Who We Are. Who We Serve.

• Trends in Health Care

• Overview of Committee Questions 1 - 47

➢ Health Care Landscape & Cost Containment

➢ Budget Agenda

➢ Customer Experience & Eligibility

➢ Hospitals

➢ Rates

➢ Miscellaneous

• Closing

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Presentation Agenda

Department Administered

Programs

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Health First Colorado

(Colorado’s Medicaid Program)

Child Heath Plan Plus (CHP+)

Old Age Pension (OAP) Medical

Programs

Colorado Indigent Care Program

(CICP)

Colorado Dental Health Care

Program for Low-Income Seniors

Health First Colorado Members

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Source: FY 2017-18 data via HCPF Annual Report.

• Nearly 1.3 Million Coloradans

• 33% of State Total Funds Budget (25% of General Fund)

• $9.6 Billion in Total Funds ($2.8 Billion in General Fund) in FY 2017-18

40% 50% 7% 3%

What are Long Term Services

and Supports?

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At Home (e.g. personal or family home; group homes; assisted living facilities)

In Community (e.g. day programs; supported employment)

Within Facilities (e.g. nursing homes; intermediate care facilities)

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Who Receives Long Term Services

and Supports?

7%

Children & Adolescents

ages 20 & younger

& qualifying former

foster care youth

49%

Older Adults

ages 65 or older

44%

Adults

ages 21-64

Source: FY17-18 data; Data represent percentage of people receiving Medicaid LTSS in various age groups.

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Department Funding and Allocation

*$9.66 billion refers to all expenditures, including administrative costs, safety

net payments, and other non-Medicaid financing arrangements - These are not

included in the $9.0 billion. The $9.0 billion includes medical services costs for

Health First Colorado and CHP+, including behavioral health and Long-Term

Services & Supports.

Sources:

FY 2019-20 Budget Request, HCPF.

Services Expenditure History by Service Category, HCPF.

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Health First Colorado

Expenditures by Population

Source: FY 2017-18 data via HCPF Annual Report.

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Child Health Plan Plus

10

CHP+ members

in 2018

81,775Children ages 19

or younger

813Prenatal women

CHP+ Health Maintenance Organizations (HMO):

• Colorado Access

• Colorado Choice Health Plans

• Denver Health Medical Plan

• Kaiser Permanente

• Rocky Mountain HMO

• State Managed Care Network

Health Care Trends & Cost

Containment

Trends in Health Care

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12

Getting Colorado Covered

Sources:

Colorado insurance coverage percentages are from the Colorado Health Access Survey, September 2017.

*National insurance coverage percentages are from U.S. Census Bureau Current Population Report, Health Insurance Coverage in the

United States: 2017, issued September 2018.

*National

Uninsured:

8.8%

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Colorado’s Uninsured

Colorado Uninsured: 6.5%***

• 32% insured part of year

• Ages 19-29 highest uninsured rate at 12.3%

• 8.1% income at or near poverty line

• 9% of employed people are uninsured

• Uninsured small business employees accounted for 40% of all

uninsured workers in the U.S.

Sources:

*State Demographer’s Office.

**Centers for Disease Control and Prevention.

***Colorado Health Institute, Colorado Health Access Survey, September 2017.

Seniors: Colorado Seniors grew by 43% between 2010-17 while the rest of the

Colorado population grew by 11.5%. Senior population is expected to grow by 57.7%

between 2017-30.*

Income Variations Across Colorado

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Health Care Affordability Challenge

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Medicaid expenditures are

33% Of the State’s Total Budget (25% of

General Fund)

Colorado Private Sector (Consumers and Employers)

$65,7182016 median income

$20,9402016 average cost of

private insurance

Sources:

Income data from Colorado DOLA LMI Gateway, US Census Median Household Income.

Colorado Department of Health Care Policy & Financing.

Health Care is

32% of median household

income

Health Care Spending

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Source: National Health Expenditure Accounts, CMS, Office of the Actuary, 2011 and 2014; Colorado Commission on Affordable Health Care.

5+ Year Health Care

Affordability Roadmap

Framework to Control Employer, Consumer, Medicaid Costs

• Health care may be the most complex industry in the U.S.

• Roadmap empowers the voices of consumers and employers

• Experts to frame options; stakeholders tailor and add options for each community

• Maximizes work to date: Cost Commission, State Innovation Model, Hospital Transformation Program, and others

• Inclusive, collaborative, evolving, impactful

The Roadmap Informs Medicaid &

Medicaid Informs the Roadmap

Stakeholder

Collaboration

Employers & Associations

Unions & Advocates

Governor’s Health Cabinet

Carriers / Payers

Regional Accountable

Entities

Providers & Associations

Elected Officials

CIVHC,QHN,COHRIO,

CHI,OeHI

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Roadmap Focus Areas

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Constrain prices, especially

hospital and prescription drugs

Champion alternative

payment models

Align and strengthen data infrastructure

Improve our population and

behavioral health

Maximize innovation

Examples of Roadmap InitiativesPharmacy Solutions

• Physician Prescribing Shared Tool

• Manufacturer-Carrier Compensation

Hospital Solutions

• Hospital Transformation Program (HTP)

• Community influence on decision

• Financial Transparency

• Centers of Excellence

Alternate Payment Methodologies

• Out Of Network Reimbursements

• Value Based Rewards

Innovations

• Prometheus

• Telehealth and E-Consults

Shared Systems Priorities

• CIVHC All Payer Claims Database

employer data

• Public Program Improved Care

Coordination

Population & Behavioral Health

• Teen vaping, adult tobacco use

• Addiction

• Suicide and Prevention

• Shared Quality Standards

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Source: Denver Chamber

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Health Care Impact on Our Economy

Health Care Trends & Cost

Containment

Questions 1 - 10

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Health First Colorado Trends

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Enrollment Trends

Adults down 6.6%

Children down 8.9%

Members with Disabilities up 5.3%

Adults 65+ up 3.7%

Cost Trend Drivers

+20% Specialty Pharmacy

+15.3% Home Health Care

+11.5% Home and Community

Based Services

Hospitals

Questions 11 - 15

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Hospital Cost Allocations and

Contributors

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Source: The Financial Health of Colorado Hospitals, Trends 2011-2015, page 10,

Colorado Hospital Association October 2017.

Source: Affordability in Colorado, Answers about Health Care Costs, Colorado

Health Institute, page 4 published December 11, 2018 available at

www.coloradohealthinstitute.org/research/affordability-colorado

Net Patient Revenue

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Source: Preliminary Department analysis of Heathcare Cost Report Information System (HCRIS) and other sources, conducted in 2018. This Growth in

Overhead Costs per Adjusted Discharge chart includes the hospital provider fee.

Total Margin

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Source: Preliminary Department analysis of Heathcare Cost Report Information System (HCRIS) and other sources, conducted in 2018. This Growth in

Overhead Costs per Adjusted Discharge chart includes the hospital provider fee.

Patient Services Margin

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Source: Preliminary Department analysis of Heathcare Cost Report Information System (HCRIS) and other sources, conducted in 2018. This Growth in

Overhead Costs per Adjusted Discharge chart includes the hospital provider fee.

Administrative Costs

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Source: Preliminary Department analysis of Heathcare Cost Report Information System (HCRIS) and other sources, conducted in 2018. This Growth in

Overhead Costs per Adjusted Discharge chart includes the hospital provider fee.

Understanding Hospital Costs:

Capital Costs

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Source: Preliminary Department analysis of Heathcare Cost Report Information System (HCRIS) and other sources, conducted in 2018. This Growth in

Overhead Costs per Adjusted Discharge chart includes the hospital provider fee.

Colorado

is 2nd to

Alaska in

Costs per

Adjusted

Discharge

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Ongoing Analysis

Colorado

more than

doubles the

national

average.

Source: Preliminary Department analysis of Heathcare Cost Report Information System (HCRIS) and other sources, conducted in 2018. This Growth in

Overhead Costs per Adjusted Discharge chart includes the hospital provider fee.

Better Data Can Inform Controlling Costs

& Improving Health Outcomes

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Chart Note: Example of Cost & Quality Quadrants

Budget Agenda

Questions 16 - 24

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2019 HCPF Budget Requests

• R6 | Local Administration Transformation

• R7 | Primary Care Alternative Payment Models

• R8 | Benefits and Technology Advisory Committee

• R9 | Long Term Home Health and Private Duty Nursing Acuity

Tool

• R10 |Transform Customer Experience

• R11 | All-Payer Claims Database Financing

• R12 | Medicaid Enterprise Operations

• R13 | Provider Rate Adjustments

• R14 | Office of Community Living Governance

• R15 | Operational Compliance and Program Oversight

• R16 | Employment First Initiatives and State Programs for People

with Intellectual and Developmental Disabilities

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Customer Experience &

Eligibility

Questions 25 - 28

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Rates

Questions 29 - 37

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Miscellaneous

Questions 38 - 47

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Thank You!

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